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de  normale  de  filniage  sont  indk^uds  ci-dessous. 

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partiellement  obscurcies  par  un  feuillet  d'errata,  une 
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obtenir  la  meilleure  image  possible. 

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possible  image  /  Les  pages  s'opposant  ayant  des 
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film^es  deux  fois  afin  d'obtenir  la  meilleure  image 
possible. 


This  item  is  filmed  at  the  reduction  ratio  checked  below  / 

Ce  docii— 5nt  est  V\\mi  eu  taux  de  ridueiion  indique  ci-dessous. 


lOx 

14x 

18x 

22x 

26x 

30x 

4 

12x 


16x 


20x 


24x 


28x 


32x 


!:r 


^^.^-X".. 


TtM  copy  ftlmvd  h«r«  has  b—n  r«produe«d  thanks 
tt»  th«  gancTMity  of: 

D.B.  WtMon  Library 
Univtrtity  of  Wttttrn  OnUrio 


L'aMamplaira  fllm4  fut  raproduit  grlca  i  la 
fltnArmit*  da: 

D.B.  WtMon  Library 
Univanity  of  Wattarn  Ontario 


Tha  imagaa  appaaring  hara  ara  tha  bast  quality 
poasibia  eensidaring  tha  condition  and  lagibillty 
of  tha  original  copy  and  In  kaaping  with  tha 
filming  contract  spacH ieationa. 


Original  eopiat  in  printad  papar  covaro  ara  fllmad 
baginning  with  tha  front  covar  and  anding  on 
tha  last  paga  with  a  printad  or  lllustratad  Impraa- 
slon,  or  tha  back  covar  whan  appropriata.  All 
othar  original  coplaa  ara  fllmad  baginning  on  tha 
first  paga  with  a  printad  or  lllustratad  Impraa- 
sion.  and  andIng  on  tha  laat  paga  with  a  printad 
or  lllustratad  imprassion. 


Las  imagas  suivantas  ont  4t*  raproduitas  avac  la 
plus  grand  soln.  compta  tanu  da  la  condition  at 
da  la  nattat*  da  i'axamplaira  film*,  at  an 
conformM  avac  las  conditions  du  contrst  da 
fllmaga. 

Laa  axamplalraa  originaux  dont  la  couvartura  an 
papiar  ast  Imprimis  sont  fiimAs  sn  commandant 
par  la  pramlar  plat  at  an  tarminant  soit  par  la 
darnlAra  paga  qui  comporta  una  amprainta 
d'imprassion  ou  d'iilustration.  soit  par  la  sacond 
plat,  aalon  la  cas.  Tous  las  autras  axamplairas 
originaux  sont  filmAs  sn  commanqant  par  la 
pramlAra  paga  qui  comporta  una  amprainta 
d'imprassion  ou  d'iilustration  at  an  tarminant  par 
la  darnlAra  paga  qui  comporta  una  talla 
amprainta. 


Tha  last  racordad  frama  on  aach  microflcha 
ahall  contain  tha  symbol  «-^  (moaning  "CON- 
TINUEL'").  or  tha  symbol  V  (moaning  "END"), 
whichavar  applias. 


Un  das  symbolaa  suivants  spparaltra  sur  la 
darnlAra  imaga  da  chaqua  microflcha.  salon  la 
cas:  la  symbola  — »  signifia  "A  SUIVRE",  la 
symbols  ▼  signifia  "FIN  ". 


Maps,  platas.  charts,  ate.  may  ba  fllmad  at 
diffarant  raduction  ratios.  Thoss  too  larga  to  ba 
antiraly  includad  in  ona  axposura  ara  fllmad 
baginning  in  tha  uppar  laft  hand  cornor.  loft  to 
right  and  top  to  bottom,  as  many  framas  aa 
raquirad.  Tha  following  diagrams  illustrata  tha 
mathod: 


Las  cartas,  planchas,  tablaaux,  ate.  pauvant  Atra 
filmas  k  daa  taux  da  riduction  diffirents. 
Lorsqua  la  document  ast  trop  grand  pour  Atra 
raproduit  an  un  saul  clich*.  ii  ast  fiimO  i  partir 
da  i'angia  supAriaur  gaucha.  da  gaucha  i  droite. 
at  da  haut  •n  bas,  an  pranant  la  nombra 
d'imagas  nacassaira.  Las  diagrammas  suivants 
illustrant  la  mithoda. 


1 

2 

3 

1  2  3 

4  5  6 


MiCIOCOPY   RKOlUTiON   TMT   CHART 

(ANSI  Old  ISO  TEST  CHART  No    2) 


1^        1^ 

|Z2 


L.0     il  2.0 


1.8 


^     /APPLIED  IIVHGE 


165J    Eos!    Mam    StrMt 

Rochester,    New    vork         14609       USA 

(716)    482  -  0300  -  Phone 

(716)    288  -  5989  -  Fo« 


THE  HYGIENE  OF  CHILDBEARING 

By  William  Ritten house,  M.  D.,  Chicago 

Profeaor  of  Obitetrics  Loyola  Univertity;  Late  Pro- 
fessor of  Obstetrics  Illinois  Medical  College. 
Jenner  Medical  College,  and  Reliance 
Medical  College;  Late  Obstetrician 
Illinois  Hospital. 

INTBODUCTORV 

This  article  is  not  intended  to  take  the  place  of  the 
family  physician,  but  merely  to  supplement  his  advice 
and  instruction.    It  is  a  well-known  fact  that  some  of 
the  accidente  and  dangers  of  childbearing  are  serious  to 
the  patient  mainly  because  she  did  not  recognize  them  in 
time  to  seek  early  help  from  her  physician.    Had  the 
doctor  been  informed  of  the  symptoms  he  might  have 
taken  measures  to  prevent  the  danger.   But  it  often  hap- 
pens that  the  patient  regards  certain  symptoms  as  harm- 
less or  unavoidable,  and  perhaps  her  friends  even  assure 
her  that  she  must  expect  to  bear  those  things  without 
murmuring,  and  so  she  fails  to  consult  her  doctor  until  it 
is  too  late.    Many  a  woman  has  lost  her  life  from  con- 
vulsions, or  other  calamities  of  childbirth  simply  because 
she  did  not  see  any  danger  in  their  early  symptoms.    If 
I  can  give  my  readers  an  intelligent  idea  of  some  of  the 
chief  dangers  of  childbearing  and  enable  them  better  to 


THE  HYGIENE  OF  CHILDBEARINO 

recognize  the  warning  signs  df  those  dangers  my  object 
will  be  accomplished. 

ABOITION 

Danger. — Abortion  or  miscarriage  is  always  accom- 
panied by  danger  whether  it  occurs  from  accidental 
causes  or  from  criminal  interference.  Of  course  criminal 
abortion  is  much  the  more  dangerous  both  because  of  the 
danger  of  infection  and  because  serious  injuries  to 
the  organs  are  often  inflicted  by  persons  ignorant  of 

anatomy. 

Early  Abortion, — An  idea  prevails  extensively  among 
the  public  that  there  is  little  danger  in  an  early  abortion. 
Doctors  often  hear  pleas  for  help  from  women  who  say 
they  have  missed  only  one  menstrual  period  and  there- 
fore they  say  there  can  be  no  danger  in  "doing  some- 
thing.'* Nothing  can  be  farther  from  the  truth.  In  an 
experience  of  thirty  years  I  have  seen  a  good  many 
women  lose  their  lives  from  abortion.  A  very  large  nui- 
jority  of  these  (over  90  per  cent,)  were  less  than  txoo 
months  pregnant. 

Reason  of  Danger, — The  reason  for  this  is  not  hard  to 
understand.  The  two  chief  dangers  in  abortion  are 
blood-poisoning  and  hemorrhage.  Very  few  die  from 
hemorrhage;  most  of  the  deaths  are  due  to  blood-poison- 
ing; and  in  early  abortion  the  danger  of  blood-poisoning 
is  greatly  increased  by  the  difficulty  of  emptying  the 
uterus,  and  the  frequency  with  which  it  is  wounded. 

Symptoms, — ^The  principal  symptoms  of  threatened 
abortion  are  pain  and  bleeding.    If  a  pregnant  woman 


THE  HYGIENK  OF  t  lULUHKAUINO 

has  pains  in  the  lower  part  of  her  body,  which  last  from 
half-a-minute  to  a  minute  an<l  return  at  re^ilar  intervaU 
nf  five  to  fifteen  niiiiutcM,  she  whouid  at  uncc  send  for 
medical  aid,  and  in  the  meantime  Khould  lie  down  and 
keep  quiet.  In  case  the  doctor  cutuiot  l>e  reached 
promptly  it  would  lie  perfectly  pn)i)er  to  take  a  tea- 
spoonful  of  paregoric  (otice)  which  mi;{ht  cheek  the 
paim  and  prevent  an  abortion.  The  pains  are  really 
contractions  of  the  womb  an<l  if  not  checked  they  will 
soon  loosen  Jie  fetus  from  its  attachment  and  tlien  the 
abortion  is  unavoidable. 

Importance  of  Bleeding. — Bleeding  from  the  womb  in 
a  pregnant  woman  whether  much  or  little  should  always 
receive  the  attention  of  the  family  ()hysician  as  soon  as 
possible,  and  until  his  arrival  the  patient  should  follow 
the  advice  given  above  for  pains.  In  the  first  half  of 
pregnancy  bleeding  from  the  womb  means  that  abortion 
is  either  actually  occurring  or  is  gravely  threatening.  In 
the  latter  half  of  pregnane}'  bleeding  is  more  serious  still, 
as  it  may  mean  Placenta  Previa,  which  is  one  of  the  most 
dangerous  conditions  the  childbearing  woman  is  ever 
called  upon  to  meet. 

FIXING  THE  DATE  OF  I^VBOR 


^Desirability. — It  is  very  desirable  both  from  the  stand- 
point of  the  doctor  and  from  that  of  the  patient  that  we 
should  be  able  to  foretell  as  nearly  as  possible  the  date  on 
which  labor  may  be  expected.  Unfortunately,  however, 
there  are  so  many  elements  of  uncertainty  in  the  problem 


THE  IIVGIENE  OF  CHILDBKARING 

Uutt  no  greftt  degree  of  tocuracy  U  potable.  The  arer- 
age  length  of  pregnancy  ia  S80  dayi,  or  40  wccki;  but 
many  pregnanciei  are  longer  than  this,  and  toine  are 
shorter.  Add  to  this  the  fact  that  the  exact  date  of  con- 
ception it  leldoni  known,  and  it  ii  clear  that  it  mutt  be 
impossible  to  foretell  the  time  of  dcUvery  very  closely. 

Method. — The  usual  metho<l  is  to  take  the  last  day  of 
the  last  menstruation,  count  back  three  months,  and  add 
five  days.  For  exa*  nie,  supiK>sc  the  last  menstmal  pe- 
riod ended  July  28nl.  Counting  back  three  months 
(which  is  more  convenient  than  counting  ahead  nine 
months)  brings  us  to  April  28rd.  Adding  five  days 
makes  April  28th  the  probable  date.  We  have  one  check 
on  this  calculation,  and  this  is  the  fact  that  the  mother 
feels  life  ("quickening")  about  the  middle  of  pregnancy, 
or  four  months  *nd  a  half  after  conception.  This,  too,  is 
subject  to  variation.  Life  may  be  felt  as  early  as  four 
months,  or  it  may  be  delayed  until  five.  But  this  sign 
has  sufficient  value  that  every  prospective  mother  should 
note  carefully  both  the  date  of  the  close  of  the  last  men- 
struatior. .  and  the  date  when  life  is  first  felt. 

A  Supentition, — In  regard  to  this  matter  of  feeling 
life  or  quickening  (as  it  was  formerly  called)  there  pre- 
vails extensively  in  the  public  mind  an  error  or  supersti- 
tion ^hat  has  come  down  from  the  ignorance  of  the  past. 
This  is  the  belief  that  the  child  actually  comes  to  life  at 
this  time  when  the  mother  first  feels  its  movements.  Of 
course,  this  is  not  true.  The  fetus  is  alive  and  makes 
movements  from  the  beginning,  but  it  is  so  small  and  its 
movements  are  so  feeble  that  they  are  not  felt  by  the 

4 


THE  HYGIEXK  OF  CHILDBKAKINC; 

mother  until  about  the  middle  of  pregnancy.  Thii  ttiper- 
itition  wmild  have  little  importance  if  it  were  not  that 
•ome  people  draw  very  lerioui  conclusions  from  it. 
Womf n  who  wish  to  avoid  motherhood  often  reason  that 
if,  ai  they  believe,  the  child  is  not  alive  before  quickening, 
then  to  produce  an  abortion  early  can  l>e  no  great  wrong. 
But  abortion  is  murder,  and  the  law  regards  it  as  such, 
whether  performed  early  or  late. 

CONVUIJUONH,  OR  Et'LAMPRIA 

A  Grave  Condition. — Most  chiid-tiearing  women 
know  that  convulsions  in  a  woman  at  alniut  the  time  of 
childbirth  are  very  dangerous,  but  comparatively  few 
know  that  they  can  usually  be  foreseen,  and,  by  proper 
treatment,  prevented.  This  condition  is  known  to  the 
profession  as  Puerperal  Eclampsia,  and  may  occur  either 
shortly  before,  during,  or  shortly  after  confinement. 
The  woman  is  suddenly  seized  with  a  violent  convulsion, 
becoming  unconscious  at  the  same  time.  The  convul- 
sion lasts  from  three  to  five  minutes,  and  following  it  the 
patient  lies  in  a  heavy,  snoring  sleep.  After  a  time  she 
may  recover  consciousness,  or  she  may  pass  into  another 
convulsion ;  and  this  may  be  repeated  until  death  ocairs. 

Treatment. — Of  course  a  doctor  should  be  obtained 
as  quickly  as  possible.  While  awaiting  his  arrival,  the 
treatment  should  \ye  limited  to  preventing  the  patient 
from  injuring  herself.  The  tongue  may  l)e  severely  bit- 
ten, and  even  the  fingers  may  get  between  the  teeth 
and  be  injured.    To  protect  the  tongue  the  handle  of  a 


s^.   .- 


THE  HYGIENE  OF  CHILDBEARING 


table  fork  covered  with  a  towel  may  be  inserted  between 
the  teeth.  If  tlie  doctor's  arrival  be  long  delayed,  the 
patient  may  be  given  a  sweat  by  means  oi'  blankets  and 
hot  water  bottles,  care  being  taken  not  to  bum  her. 
This  accident  may  easily  happen  in  the  excitement. 
She  may  also  be  given  a  large  injection  of  warm  salt- 
water (an  even  Leaspoonful  to  a  pint).  This  should  be 
passed  slowly  into  the  rectum  with  a  fountain  syringe 
lo  be  absorbed  into  the  system. 

For  the  principal  treatment,  however,  the  physician 
must  be  <lepended  upon. 

Prevention. — With  convulsions  as  with  manv  other 
troubles,  prevention  is  better  than  cure.  The  up-to-date 
physician  using  modern  methods  can  nearly  always  pre- 
vent convulsions  if  he  has  the  opportunity  to  treat  the 
patient  beforehand.  For  this  reason  a  patient  should 
always  engage  her  physician  at  least  three  months  be- 
fore her  confinement,  and  place  herself  in  his  crre  from 
that  time  on. 

Convulsions  are  due  to  a  disorder  of  the  kidneys.  It 
is  the  function  of  these  organs  to  separate  the  lu-ine  from 
the  blood,  thus  carrying  off  certain  poisonous  body- 
wastes  which  would  cause  death  if  retained  in  the  sys- 
tem. For  some  reason  not  yet  clearly  understood,  preg- 
nancy is  liable  in  some  cases  to  so  derange  the  action  of 
the  kidneys  that  the  system  is  poisoned  and  the  patient 
placed  in  great  danger.  This  condition  is  often  called 
Albuminuria  of  Pregnancy,  because  one  of  the  symp- 
toms is  usually  the  presence  of  albumen  in  the  urine.  It 
cannot  be  seen  in  the  urine  without  making  a  test. 

6 


THE  HYGIENE  OF  CHILDBEARING 


Urine  may  be  clear  as  water  and  yet  contain  much  albu- 
men. A  cloudy  sediment  in  urine  when  passed  or  form- 
ing on  cooling  is  not  albumen.  A  simple  test  that  cnn 
be  made  by  any  one  is  as  follows: 

Boil  a  little  urine  over  a  lamp  in  a  small  glass  vial  or 
even  in  a  spoon.  If  the  urine  remains  clear  there  is  no 
albumen.  If  it  becomes  cloudy  add  a  few  drops  of  vine- 
gar. If  this  makes  it  clear  again  there  is  no  albumen. 
If  the  cloudiness  remains  the  e  is  albumen.  Of  course 
this  test  should  not  take  the  place  of  the  more  complete 
and  thorough  test  by  the  physician,  but  may  be  useful 
when  he  is  not  near  at  hand. 

Swollen  Feet  as  a  Symptom. — In  albuminuria  the 
feet  and  ankles  often  become  greatly  swollen,  and  in 
some  cases  even  the  hands  and  face  become  puffy.  Such 
swelling  should  always  be  reported  to  the  physician,  and 
a  sample  of  urine  sent  to  him  for  examination.  Some- 
times this  swelling  is  quite  harmless,  being  due  to  the 
womb  pressing  on  the  large  bloodvessels,  but  only  the 
doctor  can  tell  whether  it  is  important  or  not,  so  he 
should  always  be  informed.  Some  doctors  make  it  a 
rule  to  examine  the  urine  once  a  week  during  the  last 
three  months  of  pregnancy  in  all  cases.  I  regard  this 
as  an  unnecessary  extreme  of  carefulness.  By  a  little 
instruction  the  patient  can  be  taught  to  recognize  danger 
signals  so  that  she  will  be  perfectly  safe. 

Headache. — When  albuminuria  has  become  intense 
so  that  the  danger  of  convulsions  is  very  great,  the  pa- 
tient often  experiences  severe  headache,  and  sometimes 
nausea  and  vomiting.    The  occurrence  of  these  symp- 

7 


THE  HYGIENE  OF  CHILDBEARING 

toms,  therefore,  in  a  case  where  there  has  been  more  or 
less  albumen  present,  should  be  regarded  as  a  sign  of 
the  utmost  importance,  and  no  time  should  be  lost  in  se- 
curing medical  aid. 

The  Real  Danger, — It  is  well  to  bear  in  mind  that  it 
is  not  the  loss  of  albumen  which  is  the  serious  feature  of 
these  cases.  Even  some  physicians  fail  to  grasp  this 
idea.  To  cut  albuminous  foods  out  of  the  patient's  diet 
in  the  hope  of  reducing  the  amount  of  albumen  in  the 
urine,  fails  to  touch  the  real  cause  of  the  trouble.  It  is 
not  what  she  is  losing  that  we  have  to  fear;  the  danger 
comes  from  what  she  is  not  losing.  In  other  words  the 
albumen  lost  is  comparatively  unimportant;  but  the 
poisonous  wastes  which  she  retains  in  her  system  are 
capable  of  destroying  her  life. 

SIGNS  OF  LABOR 


Sinking. — Prospective  mothers  as  well  as  doctors 
would  be  glad  if  some  way  could  be  found  of  foretelling 
the  exact  date  when  delivery  may  be  expected.  But  no 
such  way  has  ever  been  found  and  probably  never  wiU 
be.  In  most  cases  it  is  not  possible  to  tell  the  exact  time 
of  labor  until  it  actually  sets  in.  In  some  cases  the  sign 
known  as  "sinking"  gives  a  vague  warning  two  or  three 
days  in  advance.  Where  this  sign  is  well-marked  the 
pregnant  uterus  sinks  decidedly  lower,  and  the  patient 
experiences  a  sense  of  relief,  because  the  stomach  is  no 
longer  crowded  up  against  the  heart  and  lungs.  At  the 
same  time  the  shape  of  the  abdomen  is  changed  so  that 

8 


THE  HYGIENE  OF  CHILDBEARING 


I 


its  most  prominent  part  is  now  somewhat  lower  than  be- 
fore. Sometimes  more  pressure  upon  the  bladder  is  felt, 
causing  more  frequent  desire  to  urinate. 

The  value  of  this  sign  is  greatly  lessened  by  the  fact 
that  it  is  often  absent,  and  occasionally  it  occurs  three 
or  four  weeks  before  labor. 

The  Safe  Side. — The  young  mother  near  the  end  of 
her  first  pregnancy  is  often  puzzled  to  know  whether  she 
is  in  labor  or  not.  On  the  one  hand  false  pains  may 
cause  her  to  send  for  her  doctor  before  she  is  really  in 
labor;  on  the  other  hand  tnie  pains  are  sometimes  so  mild 
that  she  may  wait  too  long  before  sending  and  the  in- 
fant may  be  born  before  the  doctor's  arrival.  It  is  best 
to  be  on  the  safe  side.  Sending  too  early  can  do  no 
great  harm  but  sending  too  late  may  be  dangerous  to 
both  mother  and  child.  In  self-delivery  the  mother  is 
liable  to  be  torn  much  more  seriously  than  if  she  had 
proper  assistance,  and  the  child  may  fail  to  breathe  be- 
cause there  is  no  one  present  to  give  it  proper  care. 

False  Pains. — Many  women  in  the  last  months  of 
pregnancy  are  troubled  with  false  pains.  They  are  so 
much  like  true  pains  that  the  patient  caimot  tell  the  dif- 
ference, and  even  the  doctor,  after  making  an  examina- 
tion, may  still  be  puzzled.  They  usually  come  on  in  the 
evening  when  the  patient  is  tired,  and  disappear  during 
the  night  as  she  becomes  rested.  True  pains  are  usually 
accompanied  by  a  discharge  from  the  vagina  of  mucus, 
sometimes  streaked  with  blood.  This,  whether  streaked 
with  blood  or  not,  is  called  the  "Show,"  and  may  be  quite 
profuse,  or  it  may  be  little  more  than  the  natural  mois- 

9 


THE  HYGIENE  OF  CHILDBEARING 

ture.  When  it  is  plentiful,  and  especially  when  colored, 
it  is  a  positive  sign  of  labor.  But  it  ^  <  sometimes  slight, 
and  even  absent  altogether  in  true  labor,  so  it  cannot 
always  be  depended  upon  as  a  diagnostic  sign. 

A  full  dose  of  some  opiate  such  as  a  teaspoonful  of 
paregoric,  will  stop  false  pains  inside  of  '*orty  minutes, 
while  it  will  not  aiffect  true  labor  pains.  This  is  a  re- 
liable means  of  diagnosis  but  should  only  be  used  under 
the  physician's  advice. 

TEUE  LABOB 


In  tnie  labor  the  contractions  of  the  womb  which  are 
conii. ''^  .ly  called  "pains,"  grow  more  frequent  and  more 
powerful  as  time  goes  on.  They  may  come  only  every 
half  hour  at  first,  but  when  labor  has  fully  set  in  five 
minutes  is  a  fair  average,  although  there  is  great  varia- 
tion in  diiFerent  cases.  The  object  of  these  contractions 
is,  first,  to  open  the  womb  and,  second,  to  expel  the  child. 
We  divide  labor  into  three  stages.  The  first  is  called  the 
stage  of  dilatation,  and  ends  when  the  mouth  of  the 
womb  is  fully  open  so  that  the  head  of  the  infant  can 
pass.  This  stage  may  last  thirty-six  hours  or  it  may  be 
over  in  an  hour.    Ten  hours  is  a  fair  average. 

The  seco"  *-age  is  called  the  stage  of  expulsion,  and 
ends  when  tn*:,  child  is  completely  bom.  It  Hi^y  last  five 
minutes,  or  five  hours.  A  fair  average  is  two  hours.  If 
it  Idsts  longer  than  two  hours,  assistance  should  be  given 
in  most  cases. 

The  third  stage  is  the  expulsion  of  the  afterbirth 

10 


THE  HYGIENE  OF  CHILDBEARING 


S 

4 


(placenta)  and  membranes.    It  should  not  take  over 
lialf-an-hour. 

At  the  beginning  of  labor  the  child  lies  in  a  thin, 
closed,  membranous  sac  usually  called  "the  membranes." 
In  this  sac  surrounding  the  child  is  the  amniotic  Huid,  or 
"birth-water."  The  amount  of  this  varies  from  a  pint 
to  several  quarts.  When  the  uterus  contracts  during  a 
pain  the  pressure  on  this  water  forces  a  little  pouch  of 
membranes  through  the  mouth  of  the  womb,  thus  acting 
as  a  dilator  to  open  it.  This  pouch  is  called  the  "bag  of 
waters."  At  the  end  of  the  first  stage  when  the  womb  is 
fully  open  the  bag  of  wafers  usually  gives  way,  and  the 
water  comes  away  with  a  gush.  Sometimes  the  water 
breaks  earlier,  even  at  the  beginning  of  labor.  This 
condition  was  formerly  called  "a  dry  labor,"  and  was 
regarded  as  a  misfortune.  It  was  thought  that  the  labor 
would  be  hard  and  long.  But  better  observation  has 
taught  us  that  the  so-called  "dry"  labors  average  up  just 
as  well  as  the  others.  The  cause  of  hard  labors  lies  in 
other  conditions. 

When  the  membranes  fail  to  rupture  at  the  proper 
time  the  child  may  be  born  enclosed  in  the  sac.  This  is 
being  born  with  a  "caul"  or  a  "veil."  The  infant  must 
be  instantly  released  or  it  will  die.  Among  the  ignorant 
this  "veil"  is  dried  and  carefully  preserved.  There  is  a 
superstitious  belief  that  the  possessor  of  it  cannot  die 
frCiO  drowning. 

During  the  first  stage  of  labor  the  patient  may  be  up 
and  about.  The  pains  are  usually  more  active  when  she 
is  up  than  when  lying  down.    There  is  a  certain  amount 

11 


THE  HYGIENE  OF  CHILDBEARING 

of  work  to  be  done,  and  the  oftener  the  pains  come  the 
sooner  she  will  be  through.  Some  women,  however,  feel 
so  ill  and  weak  that  they  prefer  to  lie  down.  In  this  caae 
it  should  be  permitted. 

During  the  first  stage  the  patient  should  not  bear 
down,  or  strain.  She  would  only  be  wasting  her 
strength.  Ignorant  bystanders  often  urge  her  to  do  so, 
but  she  should  remember  that  the  womb  is  not  yet  open, 
and  that  she  cannot  expel  the  child  no  matter  how  hard 
she  tries.  She  should  save  her  strength  for  the  second 
stage,  when  the  womb  is  open  and  when  straining  and 
forcing?  may  do  good.  In  fact  nature  follows  this  plan. 
In  the  first  stage  the  patient  feels  no  inclination  to  bear 
down;  but  in  the  second  stage  the  inchnation  to  bear 
down  is  so  strong  that  she  cannot  help  it. 


SELF  DELIVERY 

It  sometimes  happens  that  the  infant  is  born  before 
the  arrival  of  the  doctor.  Wiien  this  seems  to  be  in 
danger  of  happening  the  patient  should  do  everjihin^? 
possible  to  delay  the  delivery.  She  should  lie  down, 
avoid  all  straining,  or  bearing  down,  should  not  pull  on 
anything  wi.h  her  hands,  and  when  a  pain  occurs  should 
not  hold  her  breath,  but  should  breathe  in  a  quick  pant- 
ing manner.  The  moment  she  holds  her  breath  she  hiU 
bear  down,  and  this  is  to  be  avoided  at  all  costs.  By 
following  these  suggestions  she  may  succeed  in  delay- 
ing the  delivery  so  much  that  she  will  not  be  torn;  for 
in  self-delivery  extensive  tears  are  very  apt  to  occur. 

12 


THE  HYGIENE  OF  CHILDBEARING 

Cwe  of  Infant— It  in  spite  of  all,  the  infant  is  born 
before  the  doctor's  arrival,  see  that  it  does  not  smother. 
If  it  breathes  lay  it  on  its  back  between  the  mother's 
thighs,  wipe  the  mucus  from  its  mouth  using  the  little 
finger  covered  with  a  soft  cloth,  cover  it  and  the  mother 
warmly,  and  wait  for  skilled  help.  If  it  does  not 
breathe,  wipe  out  its  mouth,  take  it  by  the  heels  and 
hold  its  head  lower  than  its  l)ody  fi>r  few  minutes;  in 
other  words,  stand  it  on  its  head.  Keep  it  warm  and  it 
will  soon  breathe.  Keeping  the  body  warm  and  stand- 
ing on  the  head  will  revive  09  per  cent,  of  all  infants 
that  are  not  actually  dead.  The  other  means  of  resusci- 
tation should  not  be  attempted  by  an  unskilled  person, 
for  fear  of  doing  more  harm  than  good. 


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